“Beyond the Statute” is a series created by Sierra Benayon-Abraham, an assistant Opinion editor and third-year public health student. In these columns, she will be exploring various public health policies, laws and experiences that different marginalized communities encounter, along with the truths behind them. It is her goal to share the importance of understanding health care on a universal level while highlighting both the disparities and inequities that exist for distinct marginalized groups. With UCLA’s campus abounding in students interested in health care, law and public policy, Bruins who have either an interest in or experience with the topic are welcome to submit op-eds or letters to the editor to be published as part of this series to represent the many facets of health care policy.

Racial prejudice and bias have been integrally woven into our health care system for centuries.

With all the data, historical accounts and lived experiences that have been compiled to prove this fact, it is time to take a long and hard look at the ways in which the American health care system must be reformed to eliminate these persistent racial disparities.

Profound racial disparities exist across America, resulting in reflective inconsistencies in overall health, well-being and life expectancy for minority groups.

Dante Anthony Tolentino, an assistant professor at the UCLA School of Nursing, studies how physiological stress and colonial mentality affect diabetes self-management and outcomes, especially for Filipino and Asian American patients.

“My research shows that racial and ethnic disparities in healthcare access and quality are deeply entrenched in structural and sociocultural systems – not merely the result of individual-level differences,” Tolentino said in an emailed statement.

Perhaps one of the most obvious examples of our health care system’s failure to address such racial inequities lies in the alarming pattern of national maternal mortality rates.

In 1933, when every state was first required to report maternal mortality deaths, the maternal mortality rate – the number of maternal deaths per 100,000 live births – for Black mothers was 1.8 times the rate of white mothers.

While the number of maternal deaths per 100,000 live births has significantly improved over the last several decades, the relative racial disparity has continued to manifest. The Black maternal mortality rate remains 2.5 times the rate of white mothers in several studies conducted over the past 30 years.

The differences in health care outcomes based on skin color are stark and far-reaching. It is not a genetic predisposition nor is it a lack of awareness that results in these patterns, as has been historically attributed, but rather the consequences from decades of structural racism.

While race has come to be best understood as a social construct, its role in health outcomes has historically been attributed to false theories – for example, eugenics – involving biological and genetic differences that supposedly exist among races.

Race-based algorithms are tools that consider race or ethnicity as a variable that influences diagnoses, treatment decisions and risk assessments.

“Race-based medicine also illustrates how structural racism is embedded in clinical decision-making,” Tolentino said in the emailed statement. “Race-based algorithms (e.g., eGFR adjustments, VBAC calculators) falsely treat race as a biological rather than a sociopolitical category. This practice reinforces the myth of innate racial difference and leads to inequitable care.”

Estimated glomerular filtration rate, which measures kidney function, included a criteria that increased the eGFR values Black patients received, which made these patients appear to have better kidney health than they actually did. This resulted in systemic exclusion of Black patients, being delayed in treatment and diagnosis of kidney disease.

Vaginal birth after cesarean calculators also included a race coefficient in their calculations of the estimated likelihood of a successful birth after a previous C-section. VBAC calculations coded racism into institutional practices by recommending against, and at times denying, Black women undergoing VBAC in favor of repeated C-sections, which come with their own medical risks.

The practice of including race in these calculators was only eliminated in June 2021.

“This is why race-conscious – not race-based – medicine is essential: we must account for racism as a determinant of health, not race as biology,” Tolentino said in the emailed statement.

Eugenics-based science and practices, even if now discredited, have continued to influence the medical system through underlying racist premises, for example, through these race-based algorithms. Pseudoscientific uses of race have long been used to hide implicit bias and structural racism and justify unequal health outcomes for racial minority groups.

People from minority communities may refrain from seeking medical resources because of a level of distrust that has only continued to evolve over the course of history, said Ernesto Sosa, director of community programs at the UCLA Kaiser Permanente Center for Health Equity.

Because of this, patients from these communities are facing worse health outcomes compared to others, Sosa added.

The Tuskegee Syphilis Study conducted by the United States Public Health Service is an example of one of these instances of historical injustices that reinforces mistrust of the American medical care system.

In 1932, more than 600 Black men were taken by the USPHS to conduct a study on the natural progression of untreated syphilis. The study was conducted without informed consent from these men, who were not informed of their diagnoses nor given treatment.

Over 100 participants died of syphilis or related medical issues over the course of the experiment.

The appalling effects of such an experiment did not end with the conclusion of the study. Instead, long-term mistrust in the American medical system has the potential to result in a lack of willingness to seek care when needed and a lack of transparency toward medical professionals.

The U.S., despite its supposedly advanced medical system, has a legacy of undermining the health of certain communities.

“We can only be healthy as a nation if all populations have optimal health,” said Fola May, an associate professor of medicine and a gastroenterologist at UCLA Health. “And we’re far from that at this point.”

Whether it be people of color experiencing a disproportionately higher level of pollution exposure or nonelderly American Indian and Alaska , Black, Hispanic and Native Hawaiian or Pacific Islander people consistently being more likely to lack health insurance, health disparities persist and will continue to do so until action is taken.

“Shift power to communities,” Tolentino said in the emailed statement. “Invest in community-based organizations, peer navigators, and research models where communities co-lead. Policy and funding structures should reflect that expertise does not solely reside in academic institutions but in lived experience and collective wisdom.”

We need to reform the way we approach health care, teach medical education, raise awareness about public health practices and advocate for policy amendments to ensure trust is reinstilled in our health care system.

Ultimately, it is time we come together to protect the health of our friends, neighbors and peers, while proudly acknowledging that this includes every race and color.